DESCRIPTION: Background: Two research topics will be addressed through analysis of secondary data from our previous Physician Referral Study (AHRQ HS06833). In the era of market competition and managed care, more and more primary physicians are dissatisfied with their jobs. We know very little about whether primary physician dissatisfaction is harming patient-physician relationships and health outcomes. Second, patients in more managed plans are less satisfied with their primary physicians, but far less is known about managed care and patient satisfaction with specialists and health outcomes. Aims: Aims are: 1) to determine the associations between managed care, primary physician satisfaction, the patient-primary physician relationship, and health outcomes; and 2) to determine the association between managed care, patient satisfaction with specialists, and health outcomes. Design: Prospective cohort study in offices of 261 primary physicians in private practice in Seattle. Patients (n=l7,187) were screened in waiting rooms, enrolling 2,850 patients in three groups: (1) patients with pain only (n=l, 5 14; 53%); (2) patients with depressive symptoms only (n=575; 20%); and (3) patients with pain and depressive symptoms (n=761; 27%). Patients (n=2004)completed follow-up surveys at one, three, and six months. About 95% of participating physicians and 96% of office managers completed self-administered questionnaires. Physician Satisfaction: Physician job satisfaction index, physician referral satisfaction index. Patient-Physician Relationship: Patient rating of primary physician, patient-primary physician relationship index, primary physician continuity, patient rating of specialists. Measures of Managed Care: For each patient, the managed-ness of the patient?s health plan, plan benefit indexes, presence or absence of a mental health carve-out, intensity of managed care in the patient?s primary care office, physician financial incentives, and whether the physician read or used AHCPR clinical guidelines for back pain and depression. Outcome Measurements: For pain patients, pain bothersomeness, pain interference, restricted activity days, and patient satisfaction with primary physician. For patients with depressive symptoms, outcomes were the Symptom Checklist for Depression, restricted activity days, and patient satisfaction with primary physician. Data Analysis: Multiple regression analysis to determine associations in Aims 1 and 2.